|
Tte w or without fol w/cont, f/u
|
$2,952.95 |
$2,952.95 |
$2,952.95 |
$1,178.00
|
|
Tubal Ligation (Laparoscopic)
|
$1,536.60 |
$1,536.60 |
$1,536.60 |
$4,323.20
|
|
Tube trach disp innr can 5 xlt
|
$213.20 |
$213.20 |
$213.20 |
$445.99
|
|
Tvh >250 gms 58290
|
$5,270.20 |
$5,270.20 |
$5,270.20 |
$6,872.92
|
|
Tvh w/mmk 58267
|
$4,773.60 |
$4,773.60 |
$4,773.60 |
$1,747.20
|
|
Tx atrial fib pulm vein isol
|
$45,258.20 |
$45,258.20 |
$45,258.20 |
$29,030.54
|
|
Tx closed distal humerus fx
|
$1,053.65 |
$1,053.65 |
$1,053.65 |
$589.00
|
|
Tx closed hip disl traumatic without anes
|
$1,092.65 |
$1,092.65 |
$1,092.65 |
$586.80
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$9,701.25 |
$9,701.25 |
$9,701.25 |
$4,043.32
|
|
Tx closed tib shaft fx without manip
|
$876.20 |
$876.20 |
$876.20 |
$535.60
|
|
Tx contour defects >10.0 cc
|
$481.00 |
$481.00 |
$481.00 |
$918.06
|
|
Tx contour defects 1.1-5.0cc 11951
|
$309.40 |
$309.40 |
$309.40 |
$849.50
|
|
Tx ectopic pregnancy ntrstl prtl rescj uter 59136
|
$3,705.00 |
$3,705.00 |
$3,705.00 |
$2,159.20
|
|
Tx l/r atrial fib addl
|
$4,333.55 |
$4,333.55 |
$4,333.55 |
$6,986.85
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$2,548.00 |
$2,548.00 |
$2,548.00 |
$4,521.61
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$9,701.25 |
$9,701.25 |
$9,701.25 |
$4,537.59
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$1,716.00 |
$1,716.00 |
$1,716.00 |
$4,595.50
|
|
Tx open nsl fx uncomp
|
$1,086.80 |
$1,086.80 |
$1,086.80 |
$3,837.72
|
|
Tx open nsl sptl fx
|
$1,760.20 |
$1,760.20 |
$1,760.20 |
$4,308.40
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$1,929.20 |
$1,929.20 |
$1,929.20 |
$4,529.60
|
|
Tx tarsal bone fx without manip 28450
|
$716.95 |
$716.95 |
$716.95 |
$423.15
|
|
Tympanic membrane repair
|
$1,278.55 |
$1,278.55 |
$1,278.55 |
$2,133.48
|
|
Tympanometry & reflex thresh
|
$406.90 |
$406.90 |
$406.90 |
$173.18
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$408.20 |
$408.20 |
$408.20 |
$911.43
|
|
Typhoid vaccine oral
|
$45.75 |
$45.75 |
$45.75 |
$63.28
|
|
Ua w/micro/comp poc
|
$18.20 |
$18.20 |
$18.20 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$4,332.90 |
$4,332.90 |
$4,332.90 |
$21,992.26
|
|
Ugt1a1 gene analy common variants
|
$1,049.75 |
$1,049.75 |
$1,049.75 |
$438.75
|
|
Ultrasound breast complete
|
$685.75 |
$685.75 |
$685.75 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$589.55 |
$589.55 |
$589.55 |
$452.00
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$620.10 |
$620.10 |
$620.10 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$637.00 |
$637.00 |
$637.00 |
$296.80
|
|
Ultrasound elastography ea l target les
|
$791.70 |
$791.70 |
$791.70 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$646.10 |
$646.10 |
$646.10 |
$307.00
|
|
Ultrasound encephalogram
|
$477.10 |
$477.10 |
$477.10 |
$485.48
|
|
Ultrasound exam k transpl w/doppler
|
$674.70 |
$674.70 |
$674.70 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$697.45 |
$697.45 |
$697.45 |
$477.10
|
|
Ultrasound Guidance for a Needle Procedure
|
$752.70 |
$752.70 |
$752.70 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$258.70 |
$258.70 |
$258.70 |
$388.08
|
|
Ultrasound guide intraoperative
|
$807.95 |
$807.95 |
$807.95 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$973.70 |
$973.70 |
$973.70 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$192.40 |
$192.40 |
$192.40 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$395.20 |
$395.20 |
$395.20 |
$304.00
|
|
Ultrasound joint complete left
|
$734.50 |
$734.50 |
$734.50 |
$560.92
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$477.10 |
$477.10 |
$477.10 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$716.95 |
$716.95 |
$716.95 |
$406.44
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$699.40 |
$699.40 |
$699.40 |
$333.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,578.20 |
$1,578.20 |
$1,578.20 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$720.20 |
$720.20 |
$720.20 |
$428.25
|
|
Ultrasound prostate/transrectal
|
$656.50 |
$656.50 |
$656.50 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$477.10 |
$477.10 |
$477.10 |
$459.00
|
|
Ultrasound transabd ea addl gest
|
$887.90 |
$887.90 |
$887.90 |
$417.15
|
|
Ultrasound trgt dyn mbubb 1st les
|
$1,219.40 |
$1,219.40 |
$1,219.40 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$718.90 |
$718.90 |
$718.90 |
$348.00
|
|
Umbilical artery cath newborn 36660
|
$364.00 |
$364.00 |
$364.00 |
$223.80
|
|
Umbilicoplasty 15847
|
$3,788.20 |
$3,788.20 |
$3,788.20 |
$4,172.97
|
|
Unlistd noninvas vasc dx std
|
$819.65 |
$819.65 |
$819.65 |
$564.60
|
|
Unlisted chemotherapy px
|
$494.65 |
$494.65 |
$494.65 |
$149.15
|
|
Unlisted cranfcl&maxlfcl px
|
$3,187.60 |
$3,187.60 |
$3,187.60 |
$571.20
|
|
Unlisted CT procedure
|
$7,061.60 |
$7,061.60 |
$7,061.60 |
$740.43
|
|
Unlisted dx gi procedure
|
$1,245.40 |
$1,245.40 |
$1,245.40 |
$649.22
|
|
Unlisted fetal invas px w/us
|
$681.85 |
$681.85 |
$681.85 |
$498.40
|
|
Unlisted fluoroscopic px
|
$24,811.15 |
$24,811.15 |
$24,811.15 |
$305.76
|
|
Unlisted laparoscopic liver biopy 47379
|
$16,735.55 |
$16,735.55 |
$16,735.55 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$7,044.05 |
$7,044.05 |
$7,044.05 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$11,460.80 |
$11,460.80 |
$11,460.80 |
$5,419.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$12,842.70 |
$12,842.70 |
$12,842.70 |
$6,463.42
|
|
Unlisted laps px appendix
|
$2,696.20 |
$2,696.20 |
$2,696.20 |
$3,617.40
|
|
Unlisted laps px bladder
|
$24,545.30 |
$24,545.30 |
$24,545.30 |
$5,082.74
|
|
Unlisted laps px endoc sys
|
$4,085.90 |
$4,085.90 |
$4,085.90 |
$5,855.00
|
|
Unlisted laps px esoph
|
$4,771.00 |
$4,771.00 |
$4,771.00 |
$5,741.00
|
|
Unlisted laps px lymphtc sys
|
$4,560.40 |
$4,560.40 |
$4,560.40 |
$6,870.89
|
|
Unlisted laps px ovidct ovry
|
$4,290.00 |
$4,290.00 |
$4,290.00 |
$6,904.15
|
|
Unlisted laps px renal
|
$7,046.00 |
$7,046.00 |
$7,046.00 |
$5,110.00
|
|
Unlisted laps px spleen
|
$4,193.80 |
$4,193.80 |
$4,193.80 |
$4,627.00
|
|
Unlisted laps px ureter
|
$5,517.20 |
$5,517.20 |
$5,517.20 |
$6,376.26
|
|
Unlisted laps px uterus
|
$6,424.60 |
$6,424.60 |
$6,424.60 |
$4,627.00
|
|
Unlisted maaa
|
$461.50 |
$461.50 |
$461.50 |
$235.20
|
|
Unlisted maxlfcl prosth px
|
$676.00 |
$676.00 |
$676.00 |
$571.20
|
|
Unlisted mr procedure
|
$7,127.25 |
$7,127.25 |
$7,127.25 |
$1,165.00
|
|
Unlisted procedure colon
|
$7,872.15 |
$7,872.15 |
$7,872.15 |
$1,839.55
|
|
Unlisted procedure esophagus
|
$13,384.15 |
$13,384.15 |
$13,384.15 |
$1,998.88
|
|
Unlisted procedure eyelids
|
$2,174.90 |
$2,174.90 |
$2,174.90 |
$2,174.90
|
|
Unlisted procedure larynx
|
$5,031.65 |
$5,031.65 |
$5,031.65 |
$924.00
|
|
Unlisted procedure liver
|
$4,366.70 |
$4,366.70 |
$4,366.70 |
$2,287.20
|
|
Unlisted procedure pancreas
|
$14,754.35 |
$14,754.35 |
$14,754.35 |
$4,810.00
|
|
Unlisted procedure rectum
|
$9,100.00 |
$9,100.00 |
$9,100.00 |
$1,278.72
|
|
Unlisted procedure spine
|
$8,660.60 |
$8,660.60 |
$8,660.60 |
$4,706.35
|
|
Unlisted px abdomen muscskel
|
$2,633.80 |
$2,633.80 |
$2,633.80 |
$2,053.50
|
|
Unlisted px accessory sinus
|
$6,248.45 |
$6,248.45 |
$6,248.45 |
$3,335.28
|
|
Unlisted px arthroscopy
|
$6,591.65 |
$6,591.65 |
$6,591.65 |
$2,765.60
|
|
Unlisted px biliary tract
|
$27,540.50 |
$27,540.50 |
$27,540.50 |
$3,055.00
|
|
Unlisted px casting/strpg
|
$195.00 |
$195.00 |
$195.00 |
$222.00
|
|
Unlisted px diaphragm
|
$28,316.60 |
$28,316.60 |
$28,316.60 |
$6,325.20
|
|
Unlisted px external ear
|
$2,056.60 |
$2,056.60 |
$2,056.60 |
$325.68
|
|
Unlisted px foot/toes
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,225.50
|
|
Unlisted px forearm/wrist
|
$3,192.15 |
$3,192.15 |
$3,192.15 |
$859.50
|
|
Unlisted px hands/fingers
|
$1,792.86 |
$1,792.86 |
$1,792.86 |
$349.70
|
|
Unlisted px leg/ankle
|
$1,931.80 |
$1,931.80 |
$1,931.80 |
$813.24
|
|
Unlisted px male genital sys
|
$10,383.75 |
$10,383.75 |
$10,383.75 |
$362.00
|
